{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T05:21:58Z","timestamp":1776316918823,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,5,7]]},"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>A girl in early childhood with no significant medical history developed left eye periorbital oedema and erythema. She was treated with intravenous antibiotics for suspected severe periorbital cellulitis. Despite treatment, the patient\u2019s cellulitis progressed into necrotising fasciitis, and she was transferred for ophthalmology review and imaging. A CT scan and eye swab culture-confirmed <jats:italic>Staphylococcus aureus<\/jats:italic> periorbital cellulitis. Incidentally, pathology revealed significant pancytopenia suspicious of leukaemia. The patient underwent bone marrow biopsy and was diagnosed with B-cell acute lymphoblastic leukaemia (ALL). A multidisciplinary specialist assessment revealed no ocular evidence of leukaemia and no intraocular concerns. In medical literature, it is consistently found that cases of ALL initially manifesting as proptosis or eyelid oedema are invariably due to neoplastic infiltration. This case represents unique documentation where periorbital cellulitis is the initial presentation of B-cell ALL, underscoring the necessity to consider periorbital cellulitis as a possible differential diagnosis in ophthalmic manifestations of ALL.<\/jats:p>","DOI":"10.1136\/bcr-2023-259087","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T13:12:20Z","timestamp":1715778740000},"page":"e259087","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Periorbital cellulitis as the initial presentation of acute lymphoblastic leukaemia"],"prefix":"10.1136","volume":"17","author":[{"given":"Charmaine","family":"Han-Menz","sequence":"first","affiliation":[{"name":"Paediatrics, Latrobe Regional Hospital, Traralgon, Victoria, Australia"},{"name":"Central Gippsland Health Service, Sale, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2568-0247","authenticated-orcid":false,"given":"Sheikh Arif Maqbool","family":"Kozgar","sequence":"additional","affiliation":[{"name":"Paediatrics, Latrobe Regional Hospital, Traralgon, Victoria, Australia"},{"name":"Monash University School of Rural Health, Traralgon, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Sohial","family":"Rana","sequence":"additional","affiliation":[{"name":"Central Gippsland Health Service, Sale, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,5,15]]},"reference":[{"key":"2025082709100066000_17.5.e259087.1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2016-311251"},{"key":"2025082709100066000_17.5.e259087.2","article-title":"Ophthalmic manifestations of acute leukemia","volume":"11","author":"Hafeez","year":"2019","journal-title":"Cureus"},{"key":"2025082709100066000_17.5.e259087.3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.leukres.2018.11.017","article-title":"Ocular manifestations in acute Lymphoblastic leukemia: A five-year cohort study of pediatric patients","volume":"76","author":"de Queiroz Mendonca","year":"2019","journal-title":"Leuk Res"},{"key":"2025082709100066000_17.5.e259087.4","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/ICU.0000000000000309","article-title":"Ophthalmic manifestations of leukemia","volume":"27","author":"Talcott","year":"2016","journal-title":"Curr Opin Ophthalmol"},{"key":"2025082709100066000_17.5.e259087.5","doi-asserted-by":"crossref","first-page":"88","DOI":"10.5301\/ejo.5000647","article-title":"Ophthalmic manifestations in recently diagnosed childhood leukemia","volume":"26","author":"Bitirgen","year":"2016","journal-title":"Eur J Ophthalmol"},{"key":"2025082709100066000_17.5.e259087.6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.xocr.2018.08.002","article-title":"Pediatric acute Lymphoblastic leukemia presenting with periorbital edema","volume":"9","author":"Stein","year":"2018","journal-title":"Otolaryngology Case Reports"},{"key":"2025082709100066000_17.5.e259087.7","doi-asserted-by":"crossref","unstructured":"Goudarzipour K , Mohammadi A , Taherian R , et al . 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